微创经皮肾取石术处理移植肾上尿路结石八例报告

Minimally invasive percutaneous nephrolithotomy in treating the upper urinary tract calculi in transplanted kidneys （report of 8 cases）

目的报告8例微创经皮肾取石术处理移植肾上尿路结石的结果，并评估其安全性和有效性。方法2002年8月至2006年10月，对8例肾移植术后发生移植肾上尿路结石的患者采用微创经皮肾取石术。在B型超声波引导下穿刺移植肾前中盏成功后，将穿刺通道扩张到F14-F16，在输尿管镜或李逊肾镜直视下将结石击碎并取出。术后每3个月随诊1次，行B型超声波、尿培养和肾功能检查。结果对所有患者进行的取石术均获成功，且1次性将结石取净，术中和术后无并发症发生。有2例患者因术中穿刺抽出液为脓性，而先置肾造瘘管引流，1周后行二期取石术。患者的手术时间平均为51min，血红蛋白平均下降了5．6g／L。术后随访时间为3～48个月，未见有结石复发；血肌酐稳定于76～131μmol／L。结论微创经皮肾取石术处理移植肾上尿路结石安全有效，可作为一线治疗方法。

Objective To report the outcome of minimally invasive percutaneous nephrolithotomy （mPCNL） in treating upper urinary tract calculi in transplanted kidney and to evaluate its safety and effectiveness. Methods Between August 2002 to October 2006, 8 patients （mean age 41 years） with upper urinary tract stones in transplanted kidneys were treated by mPCNL. Under the guidance of ultrasonography, an anterior middle calyx was performed. The percutaneous tract was dilated to F14-16 by fascial dilators and a F14-16 Peel-away sheath was placed as the percutaneous access port, a LIXUN nephroscope or a F8/9. 8 ureteroscope was used for manipulation. During follow-up, serum urea, creatinine, uric acid determinations, urine culture and ultrasound examination were pedormed every 2-3 months. Results All patients were rendered stone-free at one mPCNL procedure, with no complications during or after surgery. The mean （range） operative duration was 51 （20- 100） rain and the mean haemoglobin decrease was 5. 6 g/L. At a mean （range） follow-up duration of 21 （3-48） months no recurrence of stone was detected and the serum creatinine level was stable at 76 - 133 μmol/L in all patients. Conclusion MPCNL is safe and effective in treating the calculi in transplanted kidney and it can be as the initial therapy.